<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Title')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-title" class="form-control" name="row[title]" type="text" value="{$row.title|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">别名:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-alias_title" class="form-control" name="row[alias_title]" type="text" value="{$row.alias_title|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">公司名:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-company" class="form-control" name="row[company]" type="text" value="{$row.company|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">主治疾病:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-primary_disease" class="form-control" name="row[primary_disease]" type="text" value="{$row.primary_disease|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">注意事项:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-announcements" class="form-control" name="row[announcements]" type="text" value="{$row.announcements|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">主要成分:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-main_components" class="form-control" name="row[main_components]" type="text" value="{$row.main_components|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">用法用量:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-usage_dosage" class="form-control" name="row[usage_dosage]" type="text" value="{$row.usage_dosage|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Weigh')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-weigh" class="form-control" name="row[weigh]" type="number" value="{$row.weigh|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            {:build_radios('row[status]', ['normal'=>__('Normal'), 'hidden'=>__('Hidden')], $row['status'])}
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
